Out-of-pocket expenditure on deliveries still high despite cash incentive schemes
SRINAGAR: The NITI Aayog has painted a grim picture of the administration and information system in the Jammu and Kashmir Health department in its latest report.
The NITI Aayog’s Health Index report, which was released on Friday, also says that out-of-pocket expenditure (OOPE) on institutional deliveries is still very high in J&K, despite various cash incentive schemes to ensure free deliveries.
The PDP-BJP government, which boasts of making the J&K health sector ‘number one’ in primary and secondary healthcare, has been snubbed by the latest index on some key indicators.
The report, however, reflected a considerable improvement in overall and annual incremental performance of the main indicators.
The NITI Aayog, or the National Institution for Transforming India, a policy think tank, replaced the Planning Commission that was dismantled after the Narendra Modi government took power in New Delhi in 2014.
The report has accused the government of disturbing health governance by failing to keep the tenure of top health officials intact up to 36 months (three years), which has affected the successful implementation of various schemes including the National Health Mission (NHM). The indicator reflects the combined average occupancy (in months) of key administrative officials at the posts of Principal Secretary, Mission Director (NHM) and Director (Health Services) over the last three years.
“A stable tenure for key administrative positions is very critical for effective implementation of the programs,” the index says. “However, in Jammu & Kashmir, the occupancy has declined substantially from 22.8 months to 13.8 months from the base year (2012-15) to the reference year (2013-16), which has affected various schemes.”
“The average occupancy of key administrators and equivalent positions in a period of 36 months (3 years) is the highest in West Bengal (28 months) among the Larger States, Sikkim (24 months) among the Smaller States and Lakshadweep (27 months) among UTs,” it says.
Other indicators regarding the department’s information system capture the percentage deviation of data reported by the Health Management Information System (HMIS) from the National Family Health Survey-4 (NFHS-4) data, in order to assess the quality and integrity of the data reported.
“Specifically, data from HMIS for last 5 years (2011-12 to 2015-16) on the proportion of institutional deliveries and ANC registered within the first trimester is compared with NFHS-4 conducted during 2015-16,” the report says.
The data from J&K has showed a wide discrepancy in the case of institutional deliveries and antenatal care (ANC) registration, with a deviation of 12.4 percent and 13.5 percent respectively.
According to the Health Index figures, OOP expenditure per delivery in the J&K public health facility is more than Rs 4,000, despite huge funds having been allocated under cash-incentive schemes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK).
“Given the number of NHM interventions targeting pregnant women, such as JSY, JSSK and Referral Transport to ensure free delivery at public health facilities, the States should aim to reduce the OOP expenditure,” the NITI Aayog has told poor-performing states, including J&K.
According to the report, Kerala has topped the index while Uttar Pradesh appeared at the bottom among larger states. Kerala was followed by Punjab, Tamil Nadu and Gujarat. Besides Uttar Pradesh, Rajasthan, Bihar and Odisha are among the states that performed poorly in the health index.
The report says that among large states, Jharkhand, Jammu & Kashmir and Uttar Pradesh are the top three ranking states in terms of annual incremental performance.
Among small states, Mizoram ranked first, followed by Manipur and Goa.
The report was released on Friday by NITI Aayog CEO Amitabh Kant and its member Vinod Paul.